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The Office Of Public Insurance Counsel

http://www.opic.state.tx.us/

 

Insurance Coverage: Know Your Choices

What is a Covered Property?

Generally, covered properties are divided into four separate categories. The definitions of the property, and the extent of coverage vary by state, company and product. So it is important for the consumer to understand the definitions of the covered property. The four separate categories for your home, as defined by insurance companies, are:

1. Dwelling – The structure of the house is considered a covered property.

2. Other Structures – These are structures that are separate from the house, or connected to the house by a fence, wire or other form of connection, but not otherwise attached to the dwelling, such as a tool shed or detached garage.

3. Personal Property – The contents of your home are your personal property. This includes furniture, appliances and clothing. Not all personal property is covered. Items more appropriately covered under different forms of insurance may have limited or no coverage for loss. These items include, but are not limited to, money, jewelry and firearms.

4. Loss of Use – When a loss occurs due to a covered peril and the dwelling becomes uninhabitable, the cost of additional living expenses is covered. Reimbursement of additional living expenses covers the cost to the insured for maintaining a normal standard of living.

 

“Open Perils” and “Named Perils” Coverage

A peril, as referred to in an insurance policy, is a cause of loss, such as fire or theft. Coverage can be provided on an “all perils” basis, or a “named perils” basis. Named Perils policies list exactly what is covered by the policy, while Open Perils (or All Perils) policies will list what is excluded from coverage. Named Perils policies are generally more restrictive. A dwelling policy usually provides coverage for both the dwelling and contents on a named perils basis, while a homeowners policy usually provides coverage for the dwelling on an all perils basis, and for the contents on a named perils basis.

 

Package Versus Peril-Specific Coverage

A package policy provides coverage for multiple, but usually not all perils. A homeowners policy, for example, is a package policy typically providing coverage for the perils of fire, lightning, and extended coverage. Extended coverage includes coverage for the perils of windstorm, hail, explosion, riot, civil commotion, aircraft, vehicles, smoke, vandalism, malicious mischief, theft, and breakage of glass. Some policies, such as earthquake or flood policies, provide coverage for specific perils that are often excluded in package policies. Fire and sprinkler leakage damage as a result of an earthquake may be covered by a standard homeowners policy. To purchase the most appropriate insurance, it is important for you to consider what additional perils you may face. And, you should always verify what is covered in your specific policy.

 

Does My Policy Cover That?

1. Earthquakes – Most property insurance policies exclude coverage for losses resulting from earthquakes (although they often cover losses related to fires following earthquakes). Separate policies are typically required to ensure coverage against losses from earthquakes. Some states with risk of loss from earthquakes have government mandated insurance plans that provide earthquake coverage to property owners who are unable to obtain insurance through the voluntary market. (See page 8 for explanation of voluntary and involuntary markets.)

2. Flood – Most property insurance policies exclude coverage for losses resulting from flood. So unless you purchase a flood policy, you do not have coverage for flood losses. (For a more comprehensive discussion of flood insurance, please see Preparing for a Flood, page 25.)

3. Hail – Most property insurance policies provide coverage for losses resulting from hail. Hail is a named peril, meaning for coverage to apply under a “Named Perils” policy, hail must be defined as a covered peril.

4. Hurricanes – Most property insurance policies provide coverage for losses resulting from hurricanes, except for flood loss associated with the hurricane. (See Preparing for a Flood, page 25, for more information.) However, some policies only provide limited coverage for hurricanes, or require that a higher deductible be purchased specifically for the hurricane peril. Most states with risk of loss from hurricanes have government mandated insurance plans that provide hurricane coverage to property owners who are unable to obtain insurance through the voluntary market. (See page 8 for explanation of voluntary and involuntary markets.)

5. Tornadoes – Most property insurance policies provide coverage for losses resulting from tornadoes (although they do not cover losses resulting from the peril of flood; see Preparing for a Flood, page 25, for insurance availability). While tornadoes may not be specifically mentioned as a covered form of loss, tornado losses are one event covered under the broader term windstorm. Windstorm includes tornadoes, straight-line winds and hurricanes. However, there may be instances where coverages and deductibles may apply specifically to hurricane and not to all windstorms.6. Wildfires – All property insurance policies provide coverage for losses resulting from fires. Depending on the level of exposure, you may need to consider a higher deductible to obtain coverage, or keep it affordable. Most states have coverage available via the FAIR plan, or a JUA, if the voluntary market is not willing to provide coverage.

6. Wildfires – All property insurance policies provide coverage for losses resulting from fires. Depending on the level of exposure, you may need to consider a higher deductible to obtain coverage, or keep it affordable. Most states have coverage available via the FAIR plan, or a JUA, if the voluntary market is not willing to provide coverage.

 

 

How Much Insurance Is Enough?

Depending on the type of policy, the different dwelling coverage options could be:

1. Replacement Cost Coverage

2. Actual Cash Value

3. Special Payment - loss is paid before dwelling is repaired, rebuilt or replaced.

4. Functional Replacement Cost or Market Value Coverage - repairs are made using common, modern materials and methods without deduction for depreciation unless repairs are not made, and if a total loss, the payment amount will be the market value of the home.

5. Stated Value - a selected value is established by the insured, and this value is the limit of liability.

Depending on the coverage you select at the time of purchase of your policy, if you should incur a loss, the settlement of that loss will vary. A loss can be settled based on a replacement cost, repair cost, or actual cash value basis. Replacement cost is not the market value of your home, nor is it the tax-assessed value. It is the cost to replace the damaged property, with no reduction for depreciation of the damaged property. Actual cash value is the cost to replace the damaged property reduced by an allowance for depreciation. Functional cost or market value (also known as repair cost) is the cost to repair the damaged property with equivalent construction for similar use. An example of functional replacement would be to replace a plaster wall with drywall. If stated value coverage is selected, the maximum amount paid at the time of loss is the value of the policy, even if the loss amount is larger than the value of the policy.

 

Personal Property Coverage Choices

Depending on type of policy, the different personal property coverage options could be:

1. Replacement Cost Coverage

2. Actual Cash Value

 

What Does Insurance-to-Value Ratio Mean?

This is the relationship of the amount of insurance purchased to the replacement value of the property. It is important to have an accurate assessment of the replacement cost value of your home. If you do not, and then have a loss, the cost to actually replace your home may be more than your insurance policy will provide. That means you would be responsible for covering the difference. Major catastrophes, such as earthquakes, hurricanes, and wildfires can often create a demand surge for materials and labor, resulting in increased costs to replace damaged property. This must be considered when establishing the appropriate replacement cost for your property.

Most property policies require that the property be insured to at least 80% of the replacement cost, or loss payments will be reduced by a proportion of the insured value to 80% of replacement value. This is referred to as the coinsurance penalty.

It is also important to realize that other limits within your policy are a percentage of the dwelling coverage amount. For example, the limit of coverage for your personal property will usually be at 50% of the dwelling limit. Additional coverage is available via endorsement, and is typically increased if you purchase replacement cost coverage for your contents.

 

Replacement Cost Coverage

In order to qualify for replacement cost coverage, you will most likely be required to insure your property to at least 80% of the replacement cost. As long as this requirement is met, and if you have a total loss, your insurance policy will cover the total cost of replacing your home. Further, if the property is not insured to at least the 80% value, then the payment for partial losses may be reduced.

Additional Limits in Case of Total Loss
Many insurance companies offer an endorsement that will provide the full coverage to replace the property in the event of a total loss. Usually, the company requires that the property be insured to at least 100% of the replacement cost of the property in order to qualify for this additional coverage. As long as this requirement is met, if you have a total loss and it costs more to replace than your limit (from a misestimate or demand surge), your insurance policy will be increased. The amount of the increase depends on the endorsement purchased, and can be anywhere from 25% to 100%.

 

Optional Coverages

Additional coverages may either be included in your policy, or available for a separate price. Coverages like building code upgrades, which provide coverage for upgrades that the community requires for building codes when a home is being repaired or rebuilt as a result of a covered loss, may be available separately. Also, optional coverage for perils, such as earthquake
insurance, is often purchased to supplement a homeowners policy.

 

Ways You May Be Able To Affect Your Premium

Adjust The Deductible

A deductible is the amount of loss paid by the policyholder before any loss is paid by the insurer. The larger the deductible, the lower the premium.

A policy may have different deductibles based on the peril of the loss. Many insurers are selling homeowners insurance policies with percentage deductibles for storm damage instead of the traditional dollar value deductibles that are used for other types of claims such as fire damage and theft. One of the more common percentage deductibles is the hurricane percentage deductible, which applies to damage solely from hurricanes. Therefore a policyholder may have a $1,000 deductible for fire losses, but a 2% deductible for hurricane losses. Hurricane percentage deductibles can be very significant. An earthquake policy could add a third deductible that could very well differ from all deductibles in the homeowners policy for the same property.

Dollar Deductibles – The dollar value the insured must pay before the insurance company will pay the remainder of the claim. With a policy that has a $500 standard deductible, for example, the policyholder must pay the first $500 out of pocket. Some insurers are selling policies with higher dollar deductibles for hurricane and earthquake damage. The higher the deductible for a given policy, the lower the premium, since the insured is bearing more of the risk.

Percentage Deductibles – Percentage deductibles are based on the home’s insured value. So if a house is insured for $100,000 and has a 2% deductible, the first $2,000 (or 2% of the insurance value of $100,000) of a claim must be paid out of the policyholder’s pocket. In many states, policyholders have the option of paying a higher premium if they would rather have a traditional dollar deductible instead of a percentage one, or if they prefer to have a lower percentage deductible. Percentage deductibles are sometimes mandatory. Note that with a percentage deductible, the dollar value changes as the insured value changes.

 

Qualify For Discounts

Discounts vary widely by state and insurer. It is recommended that homeowners check the prices of multiple insurance companies before choosing a company to provide insurance coverage. The following list of potential discounts is not intended to be complete:

1. Discounts may be offered for purchasing home and auto insurance from the same insurer.

2. Discounts may be available for homes with smoke detectors, burglar alarms,
or dead-bolt locks.

3. Homes with sprinkler systems may also be eligible for discounts.

4. Discounts may be available for policyholders that are at least 55 years old and retired.

5. Some professional, alumni, and business groups qualify for discounts from some insurers.

6. Sometimes insurers give discounts for long-term policyholders.

7. The extent to which the homeowner has protected the structure from windstorm may make the home eligible for discounts for shutters, superior roof construction and connection, or other such mitigation techniques.

 

Take Care Of Your Home

1. Prior Loss – A “prior loss” is one that has occurred to the home prior to applying for insurance. The current owner of the home may or may not have been the owner of the home at the time of the loss. The treatment of prior losses varies widely by insurer. The treatment also varies widely by state. In certain areas, insurers may surcharge policies that have had a prior loss within a certain period of time.

2. Repair of Existing Conditions – Many insurers consider the existing condition of the home when determining the premium for the policy and also the availability of certain coverages or policies. Some insurers may provide a price break to policies where there has been a recent roof renovation. Different roof types may also be eligible for a discount. Complete renovations of plumbing or electrical systems may be eligible for lower premiums.

3. Post Event – It is the responsibility of the insured, and in the insured’s interest, to reduce further loss once an incident has occurred. For example, if a window is broken during a hurricane, the insured should cover the window to prevent rain from getting in the house. The costs for these actions are usually covered by the insurer.

 

Learning the Language

Do you know the difference between a dwelling form and a homeowners form? Ever wonder about buying insurance on the voluntary market versus the shared market? How about the difference between open perils and named perils?

As with any endeavor, knowledge is power. The information provided in this guide gives you the power to properly assess your insurance needs, so in the event of a natural disaster, you and your family will not be left out in the cold. To that end, the following Glossary will define many of the key terms used in the insurance industry, and thus aid in your understanding of the information presented in this guide.

Glossary of Terms

Actual Cash Value – A claim settlement provision that pays damages equal to the replacement value of damaged property minus depreciation. (See Replacement cost.)

Availability – Reference to “insurance availability” generally means when insurance is obtainable by consumers in the general marketplace.

Beach and Windstorm Plans – State-sponsored insurance pools that sell property coverage for the peril of windstorm to people unable to buy it in the voluntary market because of their high exposure to risk. Seven states (AL, FL, LA, MS, NC, SC, TX) offer these plans to cover residential and commercial properties against hurricanes and other windstorms. Georgia and New York provide this kind of coverage for windstorm and hail in certain coastal communities through other property pools. Insurance companies that sell property insurance in the state are required to participate in these plans. Insurers share in profits and losses.

Claim Settlement Provision – The provision in your insurance policy that defines the method that will be used to determine the amount of money (claim payment) the insured will receive as a result of a claim. (See Actual Cash Value, Replacement cost).

Coinsurance Provision – A provision in the policy that affects the amount of total damage that will be covered in the event of a loss. For example, if the coinsurance provision is “80% coinsurance” that means that the property must be insured for at least 80% of the full estimated replacement value. If less insurance is purchased, there will be a deduction at the time of loss
payment to reflect this.

Community Rating System Discounts – Provides premium discounts in those communities that undertake floodplain activities beyond the basic requirements of the National Flood
Insurance Program.

Coverage – The extent of protection afforded by an insurance policy.

Deductible – The portion of loss paid by the policyholder. A deductible may be a specified dollar amount, a percentage of the insured amount, or a specified amount of time that must elapse before benefits are paid. The bigger the deductible, the lower the premium charged for the same coverage.

Direct Response System – Insurance sold through direct mail, telephone or Internet.

Direct Writer System – Sales agents who are employees of the insurance companies.

Dollar Deductible – The dollar value the insured must pay before the insurance company will pay the remainder of the claim.

Dwelling Form – A policy form that only covers building property losses.

Earthquake Insurance – Covers a building and its contents in the event of an earthquake. A special policy or endorsement exists because earthquakes are not covered by standard homeowners or most business policies.

Exclusive Agency System – Independent contractors who may only represent a single insurance company.

Exposure – Possibility of loss.

FAIR Plans – FAIR ACCESS TO INSURANCE REQUIREMENTS Plans. Insurance pools that sell property insurance to people who can’t buy it in the voluntary market because of high risk over which they may have no control. FAIR Plans, which exist in 28 states and the District of Columbia, insure fire, vandalism, riot, and windstorm losses, and some sell homeowners
insurance which includes liability. Plans vary by state, but all require property insurers licensed in a state to participate in the pool and share in the profits and losses.

Flood Insurance – Coverage for flood damage is available from the federal government under the National Flood Insurance Program but is sold by licensed insurance agents. Flood coverage is excluded under homeowner’s policies and many commercial property policies. However, flood damage is covered under the comprehensive portion of an auto insurance policy.

Functional Replacement Cost – (Market value coverage) Repairs are made using common, modern materials and methods without deduction for depreciation; if a total loss, the payment amount will be the market value of the home.

Homeowners Form – Combines property coverage with liability coverage.

Homeowners Insurance – The typical homeowners insurance policy covers the house, the garage and other structures on the property, as well as personal possessions inside the house such as furniture, appliances and clothing, against a wide variety of perils including windstorms, fire and theft. The extent of the perils covered depends on the type of policy. The liability portion of the policy covers the homeowner for accidental injuries caused to third parties and/or their property, such as a guest slipping and falling down improperly maintained stairs. Coverage for flood and earthquake damage is typically excluded and must be purchased separately.

Hurricane Deductible – A percentage or dollar amount that must be paid by the policyholder in the event of a loss from a hurricane. Higher deductibles are instituted in higher risk areas, such as coastal regions. Specific details, such as the intensity of the storm for the deductible to be
triggered and the extent of the high risk area, vary from insurer to insurer and state to state.

Independent Agency System – Independent contractors who are usually free to represent multiple insurance companies.

Insurance-to-Value Ratio – The relationship of the amount of insurance purchased to the replacement value of the property.

Involuntary Market Mechanisms – Sometimes referred to as “shared markets,” these have been developed to provide coverage for entities that do not qualify for coverage in the voluntary market.

Joint Underwriting Associations (JUA) – Insurers which join together to provide coverage for a particular type of risk or size of exposure, when there are difficulties in obtaining coverage in the regular market, and which share in the profits and losses associated with the program. JUAs may be set up to provide auto and homeowner’s insurance and various commercial coverages, such as medical malpractice.

Lines of Insurance – Types of insurance available for purchase; (for example, homeowners, auto, renters, boatowners).

Loss Mitigation measures to reduce damage to property.

Loss of Use – A Provision in homeowners and renters insurance policies that reimburses policyholders for any extra living expenses due to having to live elsewhere while their home is being restored following a disaster.

Named Peril – Peril specifically mentioned as covered in an insurance policy.

National Flood Insurance Program Federal government-sponsored program under which flood insurance is sold to homeowners and businesses.

Open Peril Policies – Policies will list what is excluded from coverage.

Package Coverage – A package policy, such as a homeowners or business insurance policy, that provides coverage against several different perils. It also refers to the combination of property and liability coverage in one policy.

Percentage Deductible Percentage deductibles are based on the home's insured value.

Peril – A specific risk or cause of loss covered by an insurance policy, such as fire, windstorm, flood, or theft. A named-peril policy covers the policyholder only for the risks named in the policy in contrast to an all-risk policy, which covers all causes of loss except those specifically excluded.

Peril-Specified Coverage Coverage that will be provided only in the event of a specific peril. For example, earthquake coverage provides coverage only in the even of an earthquake.

Policy – A written contract for insurance between an insurance company and policyholder stating details of coverage.

Preferred Risk Policies The NFIP has a Preferred Risk Policy (PRP), using the Dwelling Form, for those properties in low to moderate flood risk areas.

Premium – The price of an insurance policy, typically charged annually or semiannually.

Prior Loss A loss that has occurred to the home or to the homeowner prior to applying for insurance.

Replacement Cost Coverage – Claim settlement provision that pays damages equal to the replacement cost of the damaged property with no deduction for depreciation (and subject to the limits of policy limits).

Special Payment Loss is paid before dwelling is repaired, rebuilt or replaced.

Stated Value A selected value established by the insured, and this value is the limit of liability,

Voluntary Market Refers to the insurance market that is available to everyone, at the consumer's choice.

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